LEADING CAUSES OF DEATH BY RACE (white/black)

OTHER KEY FINDINGS

• Infant mortality rates for African-American women are higher than for women in less developed countries such as Mexico, Bulgaria, Columbia, China, Jordan, Oman, Moldova, Panama and Romania.

• The infant mortality rate of 19.8 percent of African-Americans was nearly five times the white rate of 4.3, meaning an African-American mother in Hamilton County was almost five times more likely to lose a newborn than a white mother.

• More people in Hamilton County die of heart disease, cancer, stroke, respiratory disease and diabetes than the U.S. average.

• Chattanooga's growing Hispanic population has significantly lower access to health care than any other demographic studied.

• Age-adjusted 3-year mortality rates for most major causes of death have decreased in Hamilton County from a decade ago, but they remain higher than the U.S. average.

• The incidence rate of prostate cancer per 100,000 residents is 170.8, compared to 151.4 in the nation. It is unclear whether this high discrepancy is due to lifestyle factors affect this high rate, or whether doctors are more likely to diagnose prostate cancer here than elsewhere.

LEARN MORE

VIDEO

The diagnosis for Hamilton County's health is one of chronic imbalance. Touted as one of the top outdoor sporting destinations, with health care as the number two employer, the county still is plagued with obesity, disease and deep disparities in health care access.

A sobering picture painted in the 2013 State of the Chattanooga Region Health Report, conducted by the Ochs Center for Metropolitan Studies, depicts a tale of two cities: A more secure, affluent population with insurance and preventive care within reach; and a poor, urban core predisposed to bad health, with little to no access to address their primary health needs before they spiral out of control.

"For employed and insured residents of Hamilton County, the state of Chattanooga's health is relatively good," the report reads. "However, large numbers of lower-income, working poor and less educated residents experience a much different health care landscape."

These communities -- primarily black and urban -- experience high rates of mortality. They are much more prone to suffer diabetes and other diseases. They are less likely to have private insurance, and more likely to die early. Communities struggling with poverty, high rates of violent crime, and underperforming schools are "literally dying young," the report states.

It's easy for these two cities to never interact, says Ken Chilton, executive director of the Ochs Center. But a population with compounding, unmet health needs affects everyone in the bottom line of insurance premiums and overall health costs, he says.

Between 2004 and 2011, the number of uninsured patients admitted to Hamilton County hospitals and emergency rooms doubled, with more than 48,000 uninsured people admitted to local hospitals in 2011.

Health care disparity in Chattanooga is an old story, Chilton explained, with complexities that "defy easy solutions."

"If I wasn't used to seeing the data, I would have been shocked," Chilton said. "But we've seen most of this in years past."

Government agencies and nonprofits tried to target health in low-income areas, but it's an uphill battle. The hardest part is getting people in the one city to care about the epidemic in the other, says John Bilderback with Step ONE, the Hamilton County Health Department's initiative to battle obesity and promote fitness.

"People are in their own little bubbles. We're so focused on our world, or our families [and we] tend not to notice the things we drive past," he said.

Anyone would be vulnerable to these health threats, he said, if he or she were facing the same socioeconomic struggles each day.

THIN LINE

The line between easy health care access and a struggle to stay healthy can be crossed as quickly as a boss tells employees that they've been laid off.

On Tuesday, Debra Craig drove from East Brainerd to College Hill Courts to get a mammogram from Memorial Health Care System's Mobile Health Coach, which offers mammograms to women with or without insurance.

She's always had the annual screening at her doctor's office. But that wasn't an option this year. Craig, 55, worked at Olan Mills for 27 years before she lost her job. Since then, she has been looking for work on a daily basis. And she had to forgo her regular checkups. Paying for individual insurance was too expensive.

"You think you're always going to have health insurance, life insurance, to have it all taken care of," she said. "And suddenly I have to change from my regular doctors I've had for years."

She's doing what she can to keep her health in check.

Diabetes and hypertension run in her family, and she's doing everything she can to fight them off by walking and eating healthy. It's harder than it used to be, but she doesn't want to just let herself go, she says.

Too often, says Bilderback, people don't start making lifestyle changes till they've already developed a health problem. Once the diseases are contracted, African-Americans in the county are more likely than whites to die from them, the Ochs study shows.

"When you've got a group of people that has to spend most of their day trying to keep a roof over their head, making sure there's enough to eat, dealing with trouble on the street, all of that adds stress and that only aggravates health problems," he said.

But the problems begin at a much younger age, says Chilton -- even at the beginning of life.

At more than 18 percent, the low birth weight percentage among blacks in the county is nearly double that of whites, and nearly one in five black children born in the county weighs less than 5 pounds.

The statistics for pre-term births and low birth weights among children born in low-income neighborhoods are especially troubling, since both are linked to numerous health problems later in life.

COMMUNITY-BASED CHANGE

Local foundations and government initiatives have said that in spite of such disparity, simple things like access to fresh food and a safe place to walk have significant impact.

One of the new tools to improve local health is the Mobile Market, a trailer that delivers staples such as fruit, veggies, pasta, rice, eggs and cheese to the city's food deserts -- defined as areas with a high rate of poverty, low access to transportation and minimal healthy food options. More than 60,000 Chattanooga residents live in food deserts.

The market is now marking its first year on the road and has begun to attract a loyal following at the 12 locations it visits weekly, says Jeff Pfitzer, program director of Gaining Ground, which promotes local food consumption and which helped start the market, along with Step ONE and other social service groups.

Craig, who shopped at the Mobile Market in College Hill Courts after her mammogram, has easier access to supermarkets than those living in the housing development. But she said that the sight of the truck encouraged her.

"The fruit is such a good price that people can't not take advantage of it," she said after buying a few items there. "That is what we need every day."

Step ONE also has been fostering neighborhood health councils, which have rallied to start gardens, carve out green space and improve "walkability" in urban areas.

Over the last five years, the organization has started 32 gardens, some growing right on asphalt. Vacant lots have turned into parks.

"The councils are not discussing exercise or counting calories," says Bilderback. "The people that are becoming healthier are doing it because they're doing something they enjoy. Cooking food is a good angle for that. Growing food is a good angle for that."

Chilton, Bilderback and Pfitzer agree that ultimately, change is not imposed on a community. It is to be a community effort.

"There needs to be trust built within the community so that it buys in with initiatives, and gets more involved," says Pfitzer. "That is how lives are changed. At the end of the day, we're talking about a cultural shift. That's a challenge for all of us."

Chilton says initiatives like the gardens and the Mobile Market are great steps. But it is going to take significant change in other social spheres before the gaps in health care can truly begin to close.

Babies need to be born in healthier condition, he says. Schools have to build in active play time, and need to encourage health and fitness. Disparities in underperforming schools must be addressed. If more students graduate and go on to higher degrees, they have better chances of finding work. They then have more means to pay for quality food and health care. At that point, life is not just getting through the week. There is a sense of future, and of hope.

Chilton knows it's not so simple. But he points to a color-coded map in the study, showing the county's "need index."

"The zip codes with the poor health care are the same ones with high poverty, high gang violence, and poor education. It's all connected," he says. "So as a city, we've got to ask -- what are our priorities?"